HomeMy WebLinkAboutPermit Backflow Test 2008-10-9
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2008-01520 '
ISSUED: 10/09/2008
APPLIED: . 10/09/2008
EXPIRES: 04/09/2009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
54]-726-3676 Fax
54]-726-3769 Inspection Li?e
SITE ADDRESS: 3295 PINYON ST
ASSESSOR'S PARCEL NO.: 1802062405000
Springfield TYPE OF WORK: Backllow Device
TYPE OF USE: New
Residential
PROJECT DESCR]PTION: BackIlow device
Owner:
Address:
LINDA BEACH
3295 PINYON ST '
SPRINGFIELD OR 97478
Phone Number:
541-
I CONTRACTOR ~NFORM~!I?N ,I
Contractor.
, A & K LANDSCAP]NG LLC
. '; ~
{,:~..I eNTiON1 BUI~DING IN~ORMA T1?N I
.--iJ!)I<\f r' . '-'I ego
Not',,' , Illes a.d " 111a.1o/
# of Units: . , 111 i}'Ca.liol] Ce OPIE_#JoJi!o{(Ig:lires Yo
Primary Occupancy Group: 0090ARRlt32'OOI~;er. H<dgll~Pdif~<t.IW&~/o
Secondary Occupancy Group: c ,i, You ma.y bOl~T/YP.~H'.!'...reset~ fty
Primary Construction Type nu~ /!]WBe cen~e ta./!]\,lig1-e; 952_0o;th
Secondary Construction Type: . bel' for the 0 r. (i\lta~'l Ihe rUles b"
# of Bedrooms: Center is ;:9CfJridr/m . IlIIilPhone :v
. 80(Sp' Rlitlt\inu:
41 "'I)
Contractor Typ.e
Landscape
License
8146
Expiration Date
]0/31/2010
Phone
541-746-327]
Lot Size:
Sq Ft Isl Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Loail:
'n/a
I DEVELOPMENT INFORMATION 1
REQUIRED PARKING
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
"ItOr/r,\ '
I/I.J7,S PE'~'. I PUBLIC IMPROVEMENTS 1
Street Improvements: COIt1~olTl<'1orr S/fl/l
Storm Sewer AvaiIable~/lIy 78, 't:/lICE'/) 1.J/lI/)E'I/ €to/,9, .
Special Instruction: '() /)Ily A OIT IS r/fIS p 'E' I~ rlf.
'(ITIO IlBI/M 'E'1T1t1. 'E' Wo
Notes: ~ 'lJO/llE'1' 'IrIS A, 'IT/(
IJ ~Ot:> 'vOl'
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Selbacks: .
Total:
Handicapped:
Compact:
Sidewalk Type:
Downspouts/Drains:
I V al~ation Descrintion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
'Square Footage
or Bid Amount
Value
Date Calculated
Paee I of2'
_~RJ"'~li!'I!l'~~1
~
Status
Issued
CITY OF SPRINGFIELD'
Building/Com,.bination Permit
PERMIT NO: COM2008-01520
ISSUED: 10/09/2008
ApPLIED: 10/09/2008
EXPIRES: 04/09/2009
VALUE:
225 Fifth Street, Springfield, OR
54]-726-3753 Phone
54]-726-3676 Fax
54]-726-3769 Inspection Line
Total Va.'ue of Project
~~es, P~.id I
Fee Description
+ 10% Administrative Fee
+ 12% State Surcharge
+ 5% Technology Fee
Backllow Device
Minimum/Adjustment Plumbing
Amount Paid
Date Paid
Receipt Number
$5.20
$6.24
$2.60
$17,00
$35.00
]0/9/08'
10/9/08
]0/9/08
10/9/08
10/9/08
2200800000000001491
2200800000000001491
2200800000000001491
2200800000000001491
2200800000000001491
Total Amount Paid
$66.04
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
work day.
I Renuired I ns~~~ti.~n~..1
Backllow Device: Prior to covering and provide a copy of the test report on site at the time of inspection.
By signature, I state and agree, that 1 have carefully examined: the completed application and do hereby certify that all
information hereon is true and con-ect, and 1 further certify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any structure without,permission of the Community Services Division, Building Safety:
] further certity that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I further agree to ensure that all required inspections are reqnested at the proper time, that each address is readable from the'
street, that the permit card is located at the front of the property, and thc approved set of plans will remain on the site at all
times during construction.
Ai /'- ~L ~/Aui..k--
Owner or C.ontra-ctors fignat~re I
I D ,.,... Z.OCJ'i'
Date
,Page 2 of 2
22S,Fifth'Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2008-0 1520
COM2008-01520
COM2008-0 I 520
COM2008-0 I 520
COM2008-0 I 520
Payments:
Type of Payment
Check
cReceintl
RECEIPT #:
Description
Backflow Device
Minimum! Adjustment Plumbing
+ 5% Technology Fee
+ 12% State Surcharge
+ 10% Administrative Fee.
Paid By
A & K LANDSCAPING LLC
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200800000000001491
Date: 10/09/2008
Item Total:
Check Number Authorization
Received By Batch Number. Number How Received
djb 1266 In Person
Payment Total:
J
'"
Page 1 of 1
2:18:15PM
Amount Due
17.00
35,00
2.60
6.24
5.20
$66.04
Amount Paid,
$66.04
$66.04
10/9/2008